OLR Bill Analysis
sHB 6856 (as amended by House "A")*
AN ACT CONCERNING SUBSTANCE ABUSE AND OPIOID OVERDOSE PREVENTION.
This bill makes various changes affecting prescription drugs, drug abuse prevention, and related topics. Among other things, it:
1. requires practitioners, before prescribing more than a 72-hour supply of any controlled substance, to check the patient's record in the prescription drug monitoring program;
2. requires practitioners to review the patient's record at least every 90 days if prescribing for prolonged treatment;
3. makes other changes to the prescription drug monitoring program, including exempting opioid agonists in certain situations;
4. allows pharmacists to prescribe opioid antagonists, used to treat drug overdoses, if they receive special training and certification to do so, and expands the existing immunity for all prescribers when prescribing, dispensing, or administering opioid antagonists;
5. requires physicians, advanced practice registered nurses (APRNs), dentists, and physician assistants (PAs) to take continuing education in prescribing controlled substances and pain management;
6. makes changes to membership and other matters concerning the Connecticut Alcohol and Drug Policy Council; and
7. adds pharmacists to the definition of “healing arts” in the health care center (HMO) statutes.
The bill also makes technical and conforming changes.
*House Amendment “A” (1) removes a provision from the underlying bill that would require pharmacists to immediately report to the monitoring program, rather than at least weekly, on controlled substance prescriptions they fill; (2) adds a provision on prescribing more than a 72-hour supply of a controlled substance while the monitoring program is not operational; (3) adds an emergency medicine physician to the possible new members of the Alcohol and Drug Policy Council; and (4) makes a technical change to the APRN continuing education requirement.
EFFECTIVE DATE: Upon passage, except the provisions on continuing education and the prescription drug monitoring program are effective October 1, 2015.
§ 5 — ELECTRONIC PRESCRIPTION DRUG MONITORING PROGRAM
Requirements for Prescribers
Under the prescription drug monitoring program, the Department of Consumer Protection (DCP) collects information on controlled substance prescriptions to prevent improper or illegal drug use or improper prescribing.
Under the bill, before prescribing more than a 72-hour supply of a controlled substance, the practitioner or his or her authorized agent, who is also a licensed health care professional, must review the patient's records in the prescription drug monitoring program. If the program is not operational, the prescriber may prescribe more than a 72-hour supply, as long as the prescriber or agent reviews the patient's records in the program within 24 hours after regaining access to the program.
The bill also requires a prescribing practitioner or agent to review a patient's records in the program at least every 90 days when the practitioner prescribes controlled substances for continuous or prolonged treatment.
By law, various health care professionals are authorized to prescribe controlled substances, including physicians, APRNs, dentists, nurse-midwives, optometrists, PAs, podiatrists, and veterinarians.
By law, pharmacists and other controlled substance dispensers must generally report certain prescription information to DCP under the program, such as the dispensing date, dispenser identification and prescription numbers, and patient identifying information.
Existing law requires the DCP commissioner to release the information, on written request, to certain people, including a prescribing practitioner who is treating or has treated a specific patient, if the information is for treatment purposes (including drug monitoring). The bill requires the commissioner to also release the information to such a practitioner's authorized agent who is also a licensed health care professional.
Current law exempts from the program's reporting requirements institutional pharmacies or pharmacists' drug rooms operated by licensed institutions, when dispensing or administering opioid antagonists to patients to treat a substance use disorder. The bill removes this exemption and instead applies the exemption to opioid agonists.
Opioid agonists are medications such as morphine that activate the same areas of the brain as other opioids. Opioid antagonists block the effect of opioids and are often used to treat drug overdoses (see below).
§§ 6 & 8 — OPIOID ANTAGONISTS
Prescriptive Authority for Pharmacists
Under certain conditions, the bill allows licensed pharmacists to prescribe opioid antagonists. To do so, the pharmacist must (1) have been trained and certified by a program approved by the DCP commissioner and (2) act in good faith.
Under the bill, when such a pharmacist dispenses an opioid antagonist, he or she must provide training to the person on how to administer it. The pharmacist must also maintain a record of the dispensing and training under the law's recordkeeping requirements. The bill prohibits a pharmacist from delegating to or directing another person to prescribe an opioid antagonist or provide this training.
The bill specifies that a pharmacist who prescribes an opioid antagonist and meets these requirements is not deemed to have violated any standard of care for pharmacists (see below on immunity from liability).
The DCP commissioner may adopt implementing regulations.
By law, an “opioid antagonist” is naloxone hydrochloride (e.g., Narcan) or any other similarly acting and equally safe drug that the federal Food and Drug Administration has approved for treating a drug overdose.
Immunity from Liability
The bill expands the current civil and criminal immunity for licensed health care professionals authorized to prescribe an opioid antagonist, when prescribing, dispensing, or administering it to treat or prevent a drug overdose. (The immunity applies to these actions or the subsequent use of the antagonist.)
The bill removes the condition that the immunity applies only if the professional acts with reasonable care. It also makes a technical change to clarify that these professionals may prescribe, dispense, or administer the antagonist to any individual.
The bill also specifies that a professional who prescribes, dispenses, or administers an opioid antagonist in accordance with these provisions is deemed not to have violated the applicable standard of care.
§§ 1-4 — CONTINUING EDUCATION
The bill requires physicians, APRNs, dentists, and PAs to take continuing education in prescribing controlled substances and pain management, as follows:
For physicians, this applies as part of the existing requirement that they take at least one contact hour (i.e., at least 50 minutes of continuing education) of risk management training or education (1) during their first renewal period in which continuing education is required and (2) at least once every six years after that. For APRNs, the bill's requirement applies as part of the existing requirement that they take at least one contact hour of substance abuse training or education every two years. (Both physicians and APRNs generally must complete 50 hours of continuing education every two years, starting with their second license renewal.)
The bill specifies that the new requirement applies to physicians for registration periods beginning on or after October 1, 2015.
For dentists, the bill requires at least one contact hour every two years of training or education in prescribing controlled substances and pain management. The bill makes a corresponding change by providing that dentists' other continuing education must include at least one contact hour in any four, rather than five, of the 10 mandatory topics prescribed by the public health commissioner. (Dentists generally must complete 25 hours of continuing education every two years, starting with their second license renewal.)
For PAs, the bill requires at least one contact hour every two years of training or education in prescribing controlled substances and pain management. (By law, to renew their licenses, PAs must have completed the mandatory continuing education requirements needed to maintain national certification.)
§ 9 — ALCOHOL AND DRUG POLICY COUNCIL
By law, the Connecticut Alcohol and Drug Policy Council is charged with (1) reviewing state policies on substance abuse treatment programs and criminal sanctions and programs and (2) developing and coordinating a statewide plan for these matters.
Currently, the council is within the Office of Policy and Management (OPM) for administrative purposes only. The bill transfers the council to the Department of Mental Health and Addiction Services (DMHAS) for these same purposes. It eliminates the requirement that OPM, within available appropriations, provide staff for the council.
The bill also makes several changes to the council's membership. It adds to the council the aging commissioner, chairperson of the board of regents for higher education, and UConn president, or their designees. It removes as members the higher education, motor vehicles, and transportation commissioners and the chairperson of the board of pardons and paroles, or their designees. (The position of higher education commissioner was eliminated in 2011.)
The bill also allows the council's co-chairpersons, the DMHAS and children and families commissioners, to jointly appoint up to seven members, including:
1. two people in recovery from a substance use disorder or who represent an advocacy group for people with these disorders,
2. a provider of community-based substance abuse services for adults,
3. a provider of these services for adolescents,
4. an addiction medicine physician,
5. a family member of someone in recovery, and
6. an emergency medicine physician currently practicing at a hospital in the state.
§ 7 — HEALING ARTS IN HMO STATUTES
The bill adds pharmacists to the definition of “healing arts” in the HMO statutes. Various provisions in the HMO statutes refer to healing arts, including provisions on:
1. training provided under the direction of people licensed to practice a healing art (CGS §§ 38a-176 and -177),
2. required representation for healing arts practitioners on the boards of HMOs organized as corporations (CGS § 38a-179), and
3. allowing (a) healing arts practitioners to be employed by and participate in HMOs and (b) patients to choose healing arts practitioners in the HMO (CGS § 38a-180).
Pharmacists are not included in the more general statutory definition of healing arts (CGS § 20-1).
sSB 28 (File No. 329), reported favorably by the General Law Committee, bars the DCP commissioner from issuing or renewing a license of a practitioner who distributes, administers, or dispenses controlled substances if the practitioner failed to register for access to the electronic prescription drug monitoring program, as existing law requires.
HB 5782, reported favorably by the General Law and Public Health committees, authorizes pharmacists to dispense and administer opioid antagonists if they receive training and certification to do so. It also makes changes concerning immunity for providers, including specifying that a licensed professional who prescribes, dispenses, or administers an opioid antagonist in accordance with the law is deemed not to have violated the applicable standard of care.
Public Health Committee
Joint Favorable Substitute